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Soma S, Tazawa Y, Yamada S, Szuki N, Narita D. Peripheral Parenteral Nutrition and Activities of Daily Living in Hospitalized Older Frail Patients. Cureus 2023; 15:e44423. [PMID: 37791209 PMCID: PMC10544267 DOI: 10.7759/cureus.44423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Frail older adults require nursing care following hospitalization for acute illnesses. Frailty is reversible, and appropriate nutritional management and rehabilitation during hospitalization are essential. However, optimal nutritional management for patients who are unable to obtain adequate nutrition via oral intake has not been established. We aimed to determine whether peripheral parenteral nutrition (PPN) promotes the recovery of activities of daily living (ADLs) in frail older patients. METHODS This was a retrospective, observational cohort study conducted at the General Medicine Department of Aomori Prefectural Central Hospital in Aomori, Japan. The primary outcome was recovery of the Barthel index (BI) from the beginning of rehabilitation to discharge, and the secondary outcomes were the proportion of patients transferred for rehabilitation and the nutritional status. RESULTS In total, 342 patients hospitalized during the period of April 2018 to January 2022 were included, of whom 127 (37.1%) received PPN and 215 (62.9%) did not. Contrary to our expectations, recovery of the BI was lower in the PPN group than that in the non-PPN group (12.2 (95% confidence interval (CI): 8.5-16.0) vs. 22.4 (18.8-23.0); p < 0.01). Multivariable analysis revealed PPN as an independent risk factor for poor BI recovery (mean difference = -7.3 (95% CI = -12.7 to -1.9)). CONCLUSION Nutritional management through PPN for frail older adults may not improve physical activity. The nutritional management of frail patients with inadequate oral intake remains challenging.
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Affiliation(s)
- Shunsuke Soma
- Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, JPN
| | - Yuuichi Tazawa
- Nutrition Management, Aomori Prefectural Central Hospital, Aomori, JPN
| | - Shin Yamada
- Rehabilitation, Aomori Prefectural Central Hospital, Aomori, JPN
| | - Nao Szuki
- Rehabilitation, Aomori Prefectural Central Hospital, Aomori, JPN
| | - Daiki Narita
- Rehabilitation, Aomori Prefectural Central Hospital, Aomori, JPN
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Huerta-Mareca R, De-Rosende-Celeiro I, Ares-Senra L, Gálvez-Bermejo C, Pérez-Hernández E. Evaluation of improvement of functional independence in a multicentre cohort of rehabilitation outpatients with neurological conditions. Disabil Rehabil 2022; 44:8332-8338. [PMID: 34889157 DOI: 10.1080/09638288.2021.2012840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The objectives were to examine: (1) the changes in independence in basic activities of daily living (ADL) following an outpatient occupational therapy (OT) intervention in people with neurological conditions; (2) the factors associated with good relative functional gain (RFG) and with good OT efficiency; (3) and the effects on instrumental activities of daily living (IADL) and caregiver assistance. MATERIALS AND METHODS A prospective observational study examining changes in a multicentre cohort (three urban hospitals). Ninety-eight adults were assessed on admission and after intervention. Barthel Index was the primary outcome (ADL). RESULTS Acquired brain damage (ABI) was the most frequent diagnosis (84.7%). There was an improvement in ADL (p < 0.001); the effect size (r) was large (r = 0.59). RFG was good for 88.8% of participants. A good RFG was significantly associated with ABI, a lower number of hours of caregiver assistance, and a greater intensity of OT. The OT efficiency was good for 43.9% of participants. Factors significantly associated with good efficiency were being young and male patients, and receiving fewer hours of caregiver assistance. Secondary measures were improved: IADL (p < 0.001) and hours of caregiver assistance (p < 0.001). CONCLUSIONS This study suggests that the intervention is an effective approach to improve functional independence.Implications for rehabilitationLittle is known about the outcomes of outpatient occupational therapy intervention in neurorehabilitation services for the adult population with neurological diseases.In a multicentre cohort of neurorehabilitation outpatients, the occupational therapy intervention can lead to improvements in the level of independence in basic and instrumental daily activities, as well as reducing the hours of caregiver assistance.A good relative functional gain is associated with acquired brain injury, a lower number of hours of assistance, and a greater intensity of occupational therapy.The factors associated with good efficiency are being younger, male patients, and receiving fewer hours of assistance.
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Affiliation(s)
| | | | - Lucía Ares-Senra
- Rehabilitation Service, Lucus Augusti University Hospital, Lugo, Spain
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Richey LN, Rao V, Roy D, Narapareddy BR, Wigh S, Bechtold KT, Sair HI, Van Meter TE, Falk H, Leoutsakos JM, Yan H, Lyketsos CG, Korley FK, Peters ME. Age differences in outcome after mild traumatic brain injury: results from the HeadSMART study. Int Rev Psychiatry 2020; 32:22-30. [PMID: 31549522 DOI: 10.1080/09540261.2019.1657076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study longitudinally examined age differences across multiple outcome domains in individuals diagnosed with acute mild traumatic brain injury (mTBI). A sample of 447 adults meeting VA/DoD criteria for mTBI was dichotomized by age into older (≥65 years; n = 88) and younger (<65 years; n = 359) sub-groups. All participants presented to the emergency department within 24 hours of sustaining a head injury, and outcomes were assessed at 1-, 3-, and 6-month intervals. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), post-concussive symptoms (PCS) were ascertained with the Rivermead Post-Concussion Questionnaire (RPQ), and functional recovery from the Extended Glasgow Outcome Scale (GOSE). Mixed effects logistic regression models showed that the rate of change over time in odds of functional improvement and symptom alleviation did not significantly differ between age groups (p = 0.200-0.088). Contrary to expectation, older adults showed equivalent outcome trajectories to younger persons across time. This is a compelling finding when viewed in light of the majority opinion that older adults are at risk for significantly worse outcomes. Future work is needed to identify the protective factors inherent to sub-groups of older individuals such as this.
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Affiliation(s)
- Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shreya Wigh
- University of New Mexico, Albuquerque, NM, USA
| | - Kathleen T Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris I Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hayley Falk
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hunt C, Zahid S, Ennis N, Michalak A, Masanic C, Vaidyanath C, Bhalerao S, Cusimano MD, Baker A. Quality of life measures in older adults after traumatic brain injury: a systematic review. Qual Life Res 2019; 28:3137-3151. [PMID: 31522371 PMCID: PMC6864113 DOI: 10.1007/s11136-019-02297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND On average older adults experiencing TBI are hospitalized four times as often, have longer hospital stays, and experience slower recovery trajectories and worse functional outcomes compared to younger populations with the same injury severity. A standard measure of Qol for older adults with TBI would facilitate accurate and reliable data across the individual patient care continuum and across clinical care settings, as well as support more rigorous research studies of metadata. PURPOSE The aim of this systematic review was to investigate patient reported Qol measures in studies with older adults post TBI. METHOD A systematic review was carried out focusing on the various tools to measure Qol in older adults, ≥ 65 years of age with a diagnosis of TBI. Data bases searched included Medline, Embase, PubMed, CINAHL, and PsychInfo from date of inception to September 25, 2017. RESULTS A total of 20 articles met the inclusion criteria. Nine different tools were identified. CONCLUSIONS Findings based on the comparison of reliability and construct validity of the Qol measures reported in this review suggest that no single instrument is superior to all others for our study population. Future research in this field should include the enrollment of larger study samples of older adults. Without these future efforts, the ability to detect an optimal Qol measure will be hindered.
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Affiliation(s)
- Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | | | - Naomi Ennis
- Department of Psychology, Ryerson University, Toronto, ON Canada
| | - Alicja Michalak
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Cheryl Masanic
- St. Michael’s Head Injury Clinic and UHN Toronto Rehabilitation Clinic Toronto, Toronto, ON Canada
| | - Chantal Vaidyanath
- St. Michael’s Head Injury Clinic and UHN Toronto Rehabilitation Clinic Toronto, Toronto, ON Canada
| | | | - Michael D. Cusimano
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Keenan Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Andrew Baker
- Departments of Anesthesia and Critical Care, Keenan Research Centre for Biomedical Science, St. Michael’s Hospital Toronto, University of Toronto, Toronto, ON Canada
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Robbins GT, Yih E, Chou R, Gundersen AI, Schnieder JC, Bean JF, Zafonte RD. Geriatric rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:531-543. [PMID: 31753153 DOI: 10.1016/b978-0-12-804766-8.00029-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rehabilitation of elderly persons is accompanied by unique challenges, as the physiologic changes with aging may be compounded by a multitude of psychologic, social, and genetic factors. In this chapter we present an overview of the impairments that develop with aging. We discuss factors to consider when evaluating a patient with functional complaints and opportunities for treatment. We provide an overview of common injuries encountered in the elderly, prognostication, and general strategies employed for rehabilitation. New treatment options and areas of ongoing research are also discussed.
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Affiliation(s)
- Gregory T Robbins
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Erika Yih
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Raymond Chou
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Alex I Gundersen
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schnieder
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Prasad GL, Anmol N, Menon GR. Outcome of Traumatic Brain Injury in the Elderly Population: A Tertiary Center Experience in a Developing Country. World Neurosurg 2018; 111:e228-e234. [DOI: 10.1016/j.wneu.2017.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
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Comparative effectiveness of traumatic brain injury rehabilitation: differential outcomes across TBI model systems centers. J Head Trauma Rehabil 2015; 29:451-9. [PMID: 24052093 DOI: 10.1097/htr.0b013e3182a61983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To measure patient functional outcomes across rehabilitation centers. SETTING Traumatic Brain Injury Model System (TBIMS) centers. PARTICIPANTS Patients with traumatic brain injury (TBI) admitted to 21 TBIMS rehabilitation centers (N = 6975, during 1999-2008). DESIGN Retrospective analysis of prospectively collected data. MAIN MEASURES Center-specific functional outcomes of TBI patients using Functional Independence Measure, Disability Rating Scale, and Glasgow Outcome Scale-Extended. RESULTS There were large differences in patient characteristics across centers (demographics, TBI severity, and functional deficits at admission to rehabilitation). However, even after taking those factors into account, there were significant differences in functional outcomes of patients treated at different TBIMS centers. CONCLUSION There are significant differences in functional outcomes of TBI patients across rehabilitation centers.
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Chow P, Chen C, Cheong A, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Koh D, Koh GC. Factors and Trade-Offs With Rehabilitation Effectiveness and Efficiency in Newly Disabled Older Persons. Arch Phys Med Rehabil 2014; 95:1510-20.e4. [DOI: 10.1016/j.apmr.2014.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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Tan AKH, Taiju R, Menon EB, Koh GCH. Postoperated Hip Fracture Rehabilitation Effectiveness and Efficiency in a Community Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2014. [DOI: 10.47102/annals-acadmedsg.v43n4p209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: This study aims to determine the inpatient rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) of hip fracture in a Singapore community hospital (CH), its association with socio-demographic variables, medical comorbidities and admission Shah-modified Barthel Index (BI) score as well as change in independent ambulation from discharge to 4 months later. Materials and Methods: A retrospective cohort study using data manually extracted from medical records of all patients who had hip fracture within 90 days and admitted to a CH after the operation for rehabilitation. Multiple linear regressions are used to identify independent predictors of REs and REy. Results: The mean REs was 40.4% (95% Confidence Interval (CI), 36.7 to 44.0). The independent predictors of poorer REs on multivariate analysis were older age, Malay (vs non-Malay) patients, fewer numbers of rehabilitative therapy sessions and dementia. The mean REy was 0.41 units per day [CI, 0.36 to 0.46]. The independent predictors of poorer REy on multivariate analysis were higher admission BI and being non-hypertensive patient. The prevalence of independent ambulation improved from 78.9% at the discharge to 88.3% 4 months later. Conclusion: CH inpatient rehabilitative therapy showed REs 40.4% and REy of 0.41 units per day and the optimum number of rehabilitative therapy session was from 28 to 41 in terms of rehabilitation effectiveness and the maximum rehabilitation efficiency was seen in those doing 14 to 27 sessions of rehabilitative therapy. The study also showed improvement in BI at discharge and improvement in the independent ambulation 4 months after discharge from the CH.
Key words: Modified Barthel Index, Length of stay, Length of weight bearing
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Koh GCH, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open 2013; 3:e003483. [PMID: 24068767 PMCID: PMC3787469 DOI: 10.1136/bmjopen-2013-003483] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs. DESIGN Systematic review. DATA SOURCES PubMed and references in primary articles. STUDY SELECTION First, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case-control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed. RESULTS The five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy. CONCLUSIONS 5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.
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Affiliation(s)
- Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
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Cho KH, Lee WH. Effects of Inpatient Rehabilitation on Functional Recovery of Stroke Patients: a Comparison of Chronic Stroke Patients with and without Cognitive Impairment. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Sahmyook University
| | - Wan-Hee Lee
- Department of Physical Therapy, Sahmyook University
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Poynter L, Kwan J, Sayer AA, Vassallo M. Does cognitive impairment affect rehabilitation outcome? J Am Geriatr Soc 2011; 59:2108-11. [PMID: 22092047 DOI: 10.1111/j.1532-5415.2011.03658.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess how cognitive impairment affects rehabilitation outcomes and to determine whether individual benefit regardless of cognition. DESIGN Prospective open observational study. SETTING Two rehabilitation wards admitting older adults after admissions with medical or surgical problems. PARTICIPANTS Two hundred forty-one individuals admitted to two rehabilitation wards, 144 female, mean age 84.4 ± 7.3 (range: 59-103). MEASUREMENTS The Mini-Mental State Examination (MMSE) was administered, and participants were categorized into four groups: cognitively intact (MMSE score: 27-30), mildly impaired (MMSE score: 21-26), moderately impaired (MMSE score: 11-20), and severely impaired (MMSE score: 0-10). Barthel activity of daily living score was calculated on admission, at 2 and 6 weeks (if appropriate), and at discharge to assess level of independence and improvement or deterioration in function. Information relating to mortality, discharge destination, and length of stay was also collected. RESULTS After adjusting for comorbidities and age, all four groups showed improvement in Barthel score from admission to discharge. This improvement was highly significant (P = .005) in participants with normal cognition and mild to moderate impairment. Severely impaired participants also made significant improvement (P = .01). Length of stay was significantly longer for participants with lower cognitive scores. Discharge of 50% of participants occurred by 26, 28, 38, and 47 days for Groups 1 to 4, respectively (P = .001). Higher rates of institutionalization and mortality (P = .02) were associated with lower MMSE score. CONCLUSION All participants improved functionally regardless of cognition. Likelihood of institutionalization, mortality, length of stay, and adverse incidents was higher with lower MMSE scores.
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Paker N, Buğdaycı D, Tekdöş D, Kaya B, Dere C. Impact of cognitive impairment on functional outcome in stroke. Stroke Res Treat 2010; 2010. [PMID: 20798755 PMCID: PMC2925089 DOI: 10.4061/2010/652612] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 12/03/2009] [Accepted: 01/11/2010] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate the effect of the cognitive impairment on functional status in patients with subacute stroke. Fifty-two patients with subacute stroke were included in the study. Mini mental state examination (MMSE) test was used for the evaluation of cognitive status. Patients were separated into two groups according to their cognitive functions. Functional follow-up parameters were activities of daily living (ADL), global recovery and ambulation status. All patients were evaluated on admission to rehabilitation unit, at discharge and 6 months after discharge. Forty-four patients were completed the study. Mean age was 66 and 57 years; disease duration on admission was 4,8 and 3,5 months in the cognitively impaired and normal groups, respectively. Significant improvement was found in terms of functional follow-up parameters in both groups at discharge (P < .05). Functional follow-up parameters did not show statistically significant difference between the groups. But community ambulation rate was higher in cognitively normal group at the sixth month visit. As a result of this study, inpatient rehabilitation was effective both cognitively normal and impaired subacute stroke patients.
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Affiliation(s)
- Nurdan Paker
- Istanbul Physical Medicine and Rehabilitation Training Hospital, 2nd PMR Clinic, Istanbul 34180, Turkey
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15
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Yu F, Lang NM. Using the Omaha System to Examine Outpatient Rehabilitation Problems, Interventions, and Outcomes Between Clients with and Without Cognitive Impairment. Rehabil Nurs 2008; 33:124-31. [PMID: 18517148 DOI: 10.1002/j.2048-7940.2008.tb00216.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fang Yu
- University of Minnesota School of Nursing, Minneapolis, MN, USA.
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Abstract
Rehabilitation in broad terms is a process aimed at restoring a person's functional capacity particularly in relation to activities of daily living. Studies have shown that hospitalization of older patients is a major risk factor for an often irreversible decline in function, and that functional decline from baseline occurs as early as day two of admission. Rehabilitation is therefore often required for older patients following an admission to an acute hospital. Older patients admitted for rehabilitation are more likely to be functionally impaired and are more medically complex than younger patients.
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Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc 2006; 54:1590-5. [PMID: 17038079 PMCID: PMC2367127 DOI: 10.1111/j.1532-5415.2006.00894.x] [Citation(s) in RCA: 404] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three-quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI. Although geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, comorbidities, sex, and other factors such as cerebral perfusion pressure on recovery after illness or injury, these variables remain understudied in older adults with TBI. In the absence of good clinical data, predicting outcomes and providing care in the older adult population with TBI remains problematic. To address this significant public health issue, a refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes.
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Affiliation(s)
- Hilaire J Thompson
- Biobehavioral Nursing and Health Systems, Department of Medicine, University of Washington, Seattle, Washington 98195, USA.
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